Seeing Your Own Heart

2009-09-24T17:50:00.000-07:00

Though your heart is torn, nearly broken, so close to dying, stammering toward its last beat, for you, at least this time around, though you never know for how long, it is a possibility that remains an almost, an almost that will change you, will alter the way you think of yourself, your life, the body you thought you knew.

When you open your eyes after surgery, you are wandering in the days of the heart: your heart—your four-chambered muscle slightly larger than a fist that is a reminder now. Of almost-death, your flesh, the biology that is you. Your heart has become the new glare over the landscape, a now-enormous organ standing at center stage.

But breaking, is that the right word?

Yes.

For it was breaking, wasn’t it?—this muscle so often designated as the center (the center of self, the seat of love, the place of desire, longing, will, the room of testament, promises, tears, grief, loss)—breaking, wasn’t it as you sat in the car afraid for yourself, for him, as you drove through the night for help, knowing something was desperately wrong, even if it would be more accurate to express what happened as tearing since technically, it was a dissected artery that led you to the emergency room, a dissection that shoved you violently from one moment (a domestic scene of being in love, of being outside, of being on the porch, of being out in the country in the middle of July) to another (still in love, but stricken with panic now in an unanticipated, colder, more sterile environment constructed of fluorescent lights, the words “heart attack” “troponin levels,” and vomiting in the ER)?

It was a severing unexpected, a retrograde excursion running against the tide of your blood, traveling from the almost-apex of your heart up to its crown near the aorta. Luck (or timing or random chance or health or a still-steadfast body?) kept the arteries from rupturing, which would have certainly meant the end.

Split, but not torn apart, were the arteries lying on top of your heart that feed the muscle and make it possible for your left ventricle to squeeze blood out to the rest of your body.

Caught in time, repaired (but wounded at the same time since slices were made, skin, fat, and muscle peeled back, the sternum sawed in two, ribs pried apart, arteries and veins snipped, cut, and rearranged): your heart, your body, yourself. This, not because of metaphysics or a magical hand, but because of the time during which you live, the doctors you encountered, the wisdom of one surgeon who knew he needed to send you by ambulance to another, and finally, the surgeon who knew the steps to take that would keep your heart alive.

Fifty years ago you would have died. And if you had been in another city or encountered another doctor or if the first surgeon had decided to give it a try anyway, you might have died as well.

What happened to you, to your heart, is an only seemingly isolated beat wrapped in a story larger than itself. It is a rhythm moving in combination with how many years and innumerable others? When you close your eyes and see your heart, you will acknowledge the concrete circumstances that are forever a part of your continued being.

For how long? Who knows?

For as long as you want? Who can say?

For you, it’s simply luck combined with circumstance—good then bad or a combination of the two, sometimes more one than the other depending on the moment, the hour, the mood. The health of your heart, your survival, is swaddled in timing, scientific progress, privilege, smart decisions, and, of course, the beauty of steady, trained, dedicated hands. Flesh changing flesh. Flesh taking care of itself. The hands of strangers reaching into your chest.

You wake after surgery and open your eyes thanking science.

You wake after surgery and open your eyes to a new world, a strange, bewildering territory in which your suddenly visible heart stands in the spotlight singing a new tune. You learn its melody, its details (what it was before, what happened to it, how it is patched up now) to an extent you never could have anticipated; but you never had a reason to anticipate an event such as this. You commit to memory its passageways, its valves, the direction of your blood flow through its chambers and canals. In the weeks immediately following surgery you often listen for its beat. You are afraid. You take your pulse too many times a day to make sure it’s steady and to reassure yourself that you are ok.

That your heart beats approximately 100,000 times a day and pumps 2,000 gallons of blood through your body during that same time frame, that your ejection fraction rate (the fact that you even have something called an ejection fraction rate) is only at fifty percent now, which isn’t bad considering what you’ve been through, though it used to be better, but even so you shouldn’t worry says the nurse, since there is a chance it will improve, are facts you now know.

Before, your heart (biologically at least, because you are not for a moment forgetting the other heart, the symbolic one, that is also life or death and has such a monumental place in our lives) was an uncomplicated presence. A pulse you might notice every so often, but a rhythm unnoticed the majority of the time,

no more than simply

a pounding drum behind the rib cage when you’re nervous.

or a soft, steady reminder singing: I am, I am, those nights when your head on the pillow becomes an invitation for your heartbeat to lift itself into your ears.

Now it is no longer uncomplicated.

A case in point: in the immediate days (and weeks and then months) after your heart surgery, the heart you want to hear is also unwelcome. It reminds you of its mortality, its fragility. It’s a love-hate scenario of the most unexpected sort. You become over-vigilant. You notice every pulse. As you heal, sometimes the pulse is so hard it has the force to move your body. One night you see the book in your hands moving in tandem with your heart. You feel its beat throughout your chest. And if you get up too quickly or lie down too quickly or walk around too much or move too fast, your heart is everywhere. It calls out through your back when you lie down or lean against a hard surface. It is a reminder that initially brings such levels of anxiety—is it too fast, is it skipping, is it beating too hard, why is it so loud, is something wrong?

Some days you feel you are nothing but heart, that you have been reduced to a bombastic muscle weighing no more than eleven ounces with the power these days to remind you of the precipice where you nearly lost your step. Slick and damp was the moss under your giving-way feet when their arms reached out and caught you just in time.

The invisible has become visible. Not just your heart, but your body too.

You wake after surgery feeling the weight that is your flesh.

In health your body was transparent. As you moved through it, with it, you didn’t always consider what it allowed you to do. Damaged, your body has burst up from the background to speak itself to you. When you try to igonore it, your heartbeat brings you back.

You decide to write about the human heart because your own has become visible—has been made visible—on screens, charts, pictures, monitors, explanations, and even the fingers of your cardiologist tracing the arteries of the three-dimensional resin model he holds between you as you sit in his office listening to the story of your cardiac event.

You decide to write to make sense of this sudden visibility.

Through your emergency, your near-death experience (how odd that you can now say you have had one of these!) the human heart, your own animal heart, has become an actual organ, not simply an idea or vague notion, but a physical object suddenly up front and center, pushed up from the background and thrown into relief. You cannot look away or pretend you don’t see it. Your life has been split into a before and after. You examine yourself from the inside out, bracing against the strange vertigo of seeing yourself this way.

You have been split open, sewn back. More than twenty-four hours after surgery, you wake to a breathing tube, IVs, and catheters clamoring out of your chest like engorged worms. You are being drained, breathed for, morphine wraps everything in the ripples of its heavy purple, cloying fog. And there is your father. Later he tells you all you said was I am so scared. He tells you the panic in your eyes was that of an animal dying—helpless, wounded—and he had to look away.

Your body, its breaking, the way you picture it standing fragile on the edge of a cliff turning against itself, turning against you, but of course without intention, as your splitting arteries came close to pushing you into another moment that didn’t happen, though you can’t help thinking of it now. The way it could have gone: into the ultimate impossibility of the no longer that you yourself can never know where your self, your flesh, is washed, cared for, put underground, grieved for, remembered, loved, but always without you present.

From here on out even metaphors won’t be the same. “Bless your heart,” (what a friend says on seeing you for the first time after surgery) rings differently in your ears. Before, you would have simply heard the phrase as an expression of empathy. You continue hearing it this way, but you also listen and watch as her words become fingers stroking the surface of your heart.

Your heart—

silent, covered in yellow adipose tissue, wounded, stripped of its pericardium sac, vulnerable, its flesh open to the world, to the surgeon, the nurses, the anesthesiologist, the perfusionist—lying quiet and small in your chest after your heartbeat has been stopped, your body has been cooled, and just before any grafts are made.

Your surgeon took a photograph; the situation called for it, the dissection was too rare to resist. (Your cardiologist will tell you later that you [your heart] is anonymously famous in the halls of the hospital and you should know how lucky you are that it turned out this way.) You have seen this naked, bruised-looking heart reproduced from three different angles. Not anticipating the yellow, you were surprised at its color. You see the dark spots where the heart was dying and touch them slowly with your eyes, wishing them back to life, knowing those parts will always be silent.

And four days after surgery, you notice that the city through the hospital window no longer looks familiar. Landmarks have disappeared. The downtown skyline looks like a place you’ve never been. You are walking through a foreign land--sluggish, bloated, some twenty-five pounds of extra fluid pressing up from the insides against your skin (one of the results of your blood being circulated outside of your body)--as you shuffle inch by inch, so carefully, slowly, at a pace you couldn’t have foreseen. This is your life, your body, but you don’t recognize either one.

You have become strange, estranged, an imposter to yourself.

But.

You are saved. Science saves you. The intelligence of other humans saves you. Timing saves you. The love of your partner who got you to the hospital in time saves you.

And five days after surgery you are released from the hospital—to get better, to live. You leave. And, yes, you live. But soon you know you will not be able to move through your life as if it hadn’t happened, as if it were just another surgery, as your body hadn’t been peeled open,

as if you weren’t

for a few hours hulled

passed the bone and plummeting down

straight to the heart by the hands of strangers.

Though entirely unexpected, you have seen your own heart.

Denial: Or What Is the Denial of Shit?

2007-07-31T19:14:00.000-07:00

Or the blog that could be called: things that go bump in the night or the mysterious or the hidden or all those forgotten sharks circling wild beneath the surface.

I am fired up today so that makes it as good a time as any to finally start this blog. I reserved the room two months ago, so it's about time, right?

The other day at work a still-new supervisor stopped by my desk and asked me why I was a fan of Freud. (I have a Freud action figure coyly decorating my cube.) I almost answered, "Well, Mr. Supervisor, isn't it obvious--sometimes a cigar really isn't a cigar!" Of course, I didn't say that since we were in the office and he is a supervisor and the truth of the matter was that all I really wanted was for him to leave since staring up into his nostrils while he hung his head over the top of my cube was in itself becoming an all-too-ripe-for-Freudian-analysis moment. So I quickly muttered some kind of limp explanation and he finally walked away.

But I thought about it for the rest of the afternoon. What is it about Freud that appeals to me? Above all else it's his willingness to clue into the muck beneath the surface. The fact that saying "I want a cigar" might just mean something very different. And Freud is a nice reminder. Don't always believe what you here. And what people tell you is the truth could just as easily be double-speak or something shitty.

Kundera is right: kitsch most definitely is the denial of shit.

What has me going today is social denial. Related to two specific things that do dovetail at some point, even if at first blush they seem like they might not: First, responses to Michael Moore's SICKO coming from the "right" side of the political spectrum; and second, the strange term bandied about in an office party today that nagged at me all afternoon--namely, the euphemism otherwise known as a good "work ethic."

About SICKO: I read yet another critique of the movie today that claimed Moore was offering a health system such as the ones Canadians are privy to as a panacea. Well, I watched the movie. I even watched it twice. Though Moore does offer examples of places (Canada, France, Cuba) where healthcare is universal, at no time in the movie does he say "This is exactly what we need and these systems have no problems and if we had these we would no longer have any problems either." Yes, he may paint a rosy picture of these places in some parts of the film (think Moore strolling through Paris to the beat of J'taime.). And no, he doesn't explore the problems that happen in these countries' healthcare systems, but that is not what the film is about! I have to say it again: That is not what the film is about!!

In my mind the biggest questions Moore raises and the one he closes the film with are: what does it mean that we (in the U.S.) have the healthcare system we do and can't we do better than this?

Is it denial that leads so many of the critics of the film to not even touch this question? I guess you could call it: An instance when pre-packaged soundbites and predetermined politicized speech is most definitely the denial of shit. I guess the woman wandering around on skid row after being pushed out of the emergency room really wasn't that important.

And now about the work ethic thing. At the office today (In a pristine office park that is itself the denial of shit) we had a going away party for the now-ex president of the company. His parting words included talk of our work ethic--the one of all of us at the office who toil away to such a stupendous degree that is "almost insane" seem to have. He meant it as a compliment but I kept wondering at the muck beneath those words. We are underpaid, overworked and there is no such thing as overtime pay. Forget the prospect of just compensation: it's corporate life. The big guys make the bucks and the rest of us have a great "work ethic." Sure, I am a conscientious employee (whatever that means) but I also need the job. My "work ethic" isn't really a choice.

So that is a case of: When someone says work ethic and your stomach start to churn while you stand there nodding: Yes, oh yes, what a nice thing to say!

The Philosopher's Room

Seeing Your Own Heart

Denial: Or What Is the Denial of Shit?